Dsm-Iv Information

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Purpose of DSM-IV

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To provide clear descriptions of diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, study, and treat people with various mental disorders

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Subtype

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Define mutually exclusive and jointly exhaustive phenomenological subgroupings within a diagnosis and are indicated by the instruction "specify type" in the criteria set;
(ie. delusional disorder, erotomanic type; schizophrenia, paranoid type)

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Specifier

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Not mutually exclusive or jointly exhaustive; indicated by instruction "specify" or "specify if"; define a more homogeneous subgrouping of individuals with the disorder who share certain features

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Principal diagnosis

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the condition established after study to be chiefly responsible for occasioning the admission of the individual

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Axis I

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Clinical Disorders; Other conditions that may be a focus of clinical attention

Ex. Delirium, substance-related disorders, schizophrenia, mood disorders, anxiety disorders, eating, sleep, sexual and gender, etc

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Axis II

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Personality Disorders; Mental Retardation

Ex. Paranoid personality disorder, schizoid p.d., antisocial p.d., dependent p.d., mental retardation, etc

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Axis III

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General Medical Conditions

Ex. Infectious and parasitic diseases, diseases of the blood, nervous system, circulatory system, complications of pregnancy, congenital anomalies, etc.

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Axis IV

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Psychosocial and Environmental Problems

Ex. problems with primary support group, problems related to the social environment, educational, occupational, housing, economic, and access to health care problems

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Axis V

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Global Assessment of Functioning (GAF)

Rating from 0 to 100 on GAF scale (100 being superior functioning, and 1 being persistent danger of severely hurting self or others)

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Provisional

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Specifier that can be used when there is a strong presumption that the full criteria will ultimately be met for a disorder, but not enough information is available to make a firm diagnoses

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Diagnostic Criteria for Schizophrenia

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A. 2 or more characteristic symptoms, present for a significant portion of time during a 1-mo. period (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms)
B. Social/occupational dysfunction: sig. port. of 1-mo., 1 or more major area of funct (work, self-care, etc) are markedly below level achieved prior to onset
C. sign last for at least 6 months (at least 1 mo. of Crit A symptoms)
D. Schizoaffective and Mood Disorder exclusion
E. Substance/gen med cond exclusion
F. relationship to pervasive dev. disorder: if history of autistic dis, schizophrenia diag only made if prominent delusions or hallucinations are present for >=1 mo

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Schizophreniform Disorder Diagnostic criteria

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A. Criteria A, D, and E of Schizophrenia are met
B. >1 mo., <6 mo.

Specify if: Without good prognostic features

With good prognostic features:
1) onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior
2) confusion or perplexity at the height of the psychotic episode
3) good premorbid social and occupational functioning
4) absence of blunted or flat affect

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Diagnostic Criteria for Schizoaffective Disorder

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A. Major Depressive Episode, Manic episode, or mixed episode concurrent with Crit A schizophrenia symptoms
B. during illness, dulusions or hallucinations present for at least 2 weeks in absence of prominent mood symptoms
C. Symptoms that meet criteria for a mood episode are present for a subs. portion of total duration of actie and residual periods of illness
D. not due to direct physiol. effects of substance or gmc

Specify type:
-Bipolar Type
-Depressive Type-ONLY Maj Dep episode

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Delusional disorder

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A. Nonbizarre delusions for >=1 mo.
B. Crit. A for Schiz. never met (excluding tactile & olfactory hallucinations that go with theme)
C. functioning is not markedly imparied and behavior not clearly odd or bizarre
D. mood episodes only present for brief time relative to duration of delusional periods
E. not due to substance or gmc

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Brief Psychotic Disorder Diagnostic Criteria

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A. Presence of 1+ of following:
1) delusions
2) hallucinations
3) disorganized speech
4) grossly disorganized or catatonic behavior
B. at least 1 day, less than 1 month
C. not better accounted for by a Mood Disorder with Psychotic Features, substance, or gmc

Specify if:
With marked stressor(s): occur shortly after and in response to stressful events
Without marked stressor(s): do not " " " "
With Postpartum onset: within 4 weeks postpartum

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Shared Psychotic Disorder Diagnostic Criteria

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A. delusion develops because of relationship with someone who already has an established delusion
B. delusion is similar to that of person who already has it
C. not better accounted for by Psychotic Disorder or Mood Dis w/ psych feat, substance, or gmc

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Positive Characteristic Symptoms (Criteria A1-A4) of Schizophrenia

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1) distortions of thought content (delusions)
2) perception (hallucinations)
3) language and thought process (disorganized speech)
4) Self-monitoring of behavior (grossly disorganized or catatonic behavior)

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Negative Characteristic Symptoms (Criterion A5) of Schizophrenia

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1) restrictions in the range and intensity of emotional expression (affective flattening)
2) restrictions in the fluency and roductivity of thought and speech (alogia)
3) restrictions in the initiation of goal-directed behavior (avolition)

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Delusions (Criterion A1)

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erroneous beliefs that usually involve a misinterpretation of perceptions or experiences (persecutory, referential, somatic, religious, or grandiose);

Delusions are deemed bizarre if they are clearly implausible and not understandable and do not derive from ordinary life experiences - only this single symptom is needed to satisfy Criterion A for schizophrenia

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Hallucinations (Criterion A2)

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occur in any sensory modality, but auditory is the most common - usually experienced as voices that are perceived as distinct from the person's own thoughts

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Disorganized Speech (Criterion A3)

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1) "slip off the track" from one topic to another ("derailment" or "loose associations")
2) answers to questions may be obliquely related or completely unrelated ("tangentiality")
3) speech may be so severely disorganized that it is nearly incomprehensible and resembles receptive aphasia in its linguistic disorganization ("incoherence" or "word salad")

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Grossly Disorganized Behavior (Criterion A4)

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Examples: wearing multiple layers of clothing on a hot day, public masturbation, untriggered agitation (shouting, swearing)

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Catatonic Motor Behaviors (Criterion A4)

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Include:
1) a marked decrease in reactivity to the environment (catatonic stupor)
2) maintaining a rigid posture and resisting efforts to be moved (catatonic rigidity)
3) active resistance to instructions or attempts to be moved (catatonic negativism)
4) the assumption of inappropriate or bizarre postures (catatonic posturing)
5) purposeless and unstimulated excessive motor activity (catatonic excitement)

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Personality Disorder

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an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the indiidual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment

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Personality traits

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enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts.

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General diagnostic criteria for a Personality Disorder

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A) significant deviation from the expectations of the individual's culture in two or more of the following areas:
1) cognition (i.e., ways of perceiving and interpreting self, other people, and events)
2) affectivity (i.e., the range, intensity, lability-often fluctuating, and appropriateness of emotional response)
3) interpersonal functioning
4) impulse control

B)inflexible and pervasive across broad range of personal and social situations

C) clinically significant distress or impairment in social, occupational, or other important areas of functioning

D) stable and of long duration, onset in adolescence or early adulthood

E) Not better accounted for as consequence of another mental disorder

F) not due to direct physiological effects of a substance

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Schizophrenia, Paranoid Type Diagnostic Criteria

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A. Preoccupation with one or more delusions or frequent auditory hallucinations
B. None of following are prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect

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Schizophrenia, Disorganized Type Diagnostic Criteria

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A. All of the following are prominent:
1) disorganized speech
2) disorganized behavior
3) flat or inappropriate affect

B. The criteria are not met for Catatonic Type

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Schizophrenia, Catatonic Type Diagnostic Criteria

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Clinical picture is dominated by 2 of the following:
1) motoric immobility as evidenced by catalepsy or stupor
2) excessive motor activity (purposeless and not influenced)
3) extreme negativism (motiveless resistance or maintenance of rigid posture against attempts to be moved) or mutism (not talking)
4) peculiarities of voluntary movement as evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing
5) echolalia (the uncontrollable & immediate repetition of words spoken by another person) or echopraxia (abnormal repetition of actions of another person)

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Schizophrenia, Residual Type Diagnostic Criteria

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A. Absense of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.
B. Continuing evidence of disturbance (negative symptoms or 2+ Crit A symptoms)

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Types of Delusional Disorders

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1) Erotomanic
2) Grandiose
3) Jealous
4) Persecutory
5) Somatic
6) Mixed
7) Unspecified

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Erotomanic Delusional Type

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delusions that another person, usually of higher status, is in love with the individual

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Grandiose Delusional Type

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delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person

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Jealous Delusional Type

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delusions that the individual's sexual partner is unfaithful

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Persecutory Delusional Type

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delusions that the person (or someone to whom the person is close) is being malevolently treated in some way

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Somatic Delusional Type

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delusions that the person has some physical defect or general medical condition

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Mixed Delusional Type

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delusions characteristic of more than one of the above types but no one theme predominates